LINCOLN, Neb. (KMTV) — In the last few years, pharmacists across the state have left the industry due to slim margins and the heavy workload.
At the same time, Pharmacy Benefit Managers who serve as the middleman between pharmacies and drug companies have made huge profits.
In Lincoln Monday, pharmacists across the state told senators they’re barely making it.
“Last year I did over 7 million dollars in sales and struggled to break even,” says Robert Moser, who owns a pharmacy.
Yet they say the middle man, known as Pharmacy Benefit Managers (PBM's) are making plenty off their businesses.
“During that same year, an unregulated, unnecessary industry of middlemen, profited over two-million dollars off of my store alone,” says Moser.
State senator Adam Morfeld is proposing a bill that regulates these huge, third party administrators.
Currently, on some plans controlled by PBM’s, patients are forced to get prescriptions by mail.
That includes Amy Pick, whose son has juvenile idiopathic arthritis and needs two medications. She says she can pick the first one up at her local pharmacy, but her PBM forces her to receive her second by mail order.
“I ask the UPS man to typically put that behind the pillar, because I always worry it’s going to be stolen. It’s about five thousand dollars worth of medications and it sits outside until I can get home and put it in the refrigerator,” says Pick.
This bill would give patients the option to simply pick up their meds.
“I just want the ability to go to my local community pharmacy and also receive this medication,” says Pick.
David Root, who represents a PBM, says his company helps bring the cost of drugs down, forcing drug companies to compete on price, pharmacies to compete on service and providing huge mail order and specialty pharmacies, giving them more negotiating power.
In response to Pick’s situation, he says it’s up to employers to pick a plan, even if it’s the more restrictive mail order one.
“They’re allowed to have that choice if they want to,” says Pick. “Exercising the savings a PBM can offer.”
Opponents say they’re working on a bill that works better for them, that also would solve some of the problems pharmacists and patients are having.
“Cost sharing is going up, and they are, as are premiums, everything is going up, the cost of healthcare is going up and really what we need to look at is lowering that cost,” says Robert Bell, executive director of Nebraska Insurance Federation.
The bill would also force an audit on all PBM’s. Supporters say when other states have done this, they found that PBM’s are underpaying pharmacies.
Mark Patefield, who owns two pharmacies in northeast Nebraska says West Virginia got rid of PBM’s for their Medicaid program, to great success.
“They were both able to pay pharmacies at a more fair level and save 54 million dollars in 2018,” says Patefield.
